Visiting the sick is so important in the healing process Nedarim 39

 I have plenty of experience from both sides of the hospital bed when it comes to the topic of today's daf TB Nedarim 39, bikur holim (בִּיקור חוֹלִם), visiting the sick. Bikur holim is one of the 613 commandments found in the Torah. "Reish Lakish said: From where is there an allusion from the Torah to visiting the ill? It is as it is stated: “If these men die the common death of all men, and be visited after the visitation of all men, then the Lord has not sent me” (Numbers 16:29). The Gemara asks: From where in this verse may visiting the ill be inferred? Rava said that this is what Moses is saying: If these men, the congregation of Korah, die the common death of all men, who become ill, and are confined to their beds, and people come to visit them; if that happens to them, what do the people say? They say: The Lord has not sent me for this task." (Sefaria.org translation) In the book of Numbers (במדבר) Korah and his followers challenged Moses' leadership in order to usurp it. Moses says if these people die a natural death than he is not God's chosen leader. The Torah records that in the end the earth opened up its mouth and swallowed them alive proving that their challenge was illegitimate and Moses was the worthy leader of the Jewish people. Moses assumed that if they become sick, people will observe the commandment of bikur holim and visit them.

The Gemara goes on to teach how important the mitzvah of visiting the sick truly is. "It is taught in a baraita: The mitzva of visiting the ill has no fixed measure. The Gemara asks: What is the meaning of: Has no fixed measure? Rav Yosef thought to say: There is no fixed measure for the granting of its reward. Abaye said to him: And do all other mitzvot have a fixed measure for the granting of their reward? But didn’t we learn in a mishna (Avot 2:1): Be as meticulous in the observance of a minor mitzva as a major one, as you do not know the granting of reward for mitzvot. Rather, Abaye said: There is no fixed measure for the disparity between the ill person and his visitor, as even a prominent person pays a visit to a lowly person and should not say that doing so is beneath a person of his standing. Rava said: There is no fixed measure for the number of times that one should visit the ill, as even one hundred times a day is appropriate.

"Rav Aḥa bar Ḥanina said: Anyone who visits an ill person takes from him one-sixtieth of his suffering." (Sefaria.org translation)

A person in the hospital is scared, despondent, and alone. When people come to visit, they show through their actions that the person in the hospital is not alone and people are compassionately concerned about them. This visit lifts their spirits and they feel better. As a rabbi I know how much my visiting somebody in the hospital means to him/her. As a person who spent a month in a hospital in Israel and 10 weeks in two different rehabs, I know how much those bikur holim visits meant to me. 

One of my college friends who lives in Israel traveled over two and half hours and had to take three buses to visit me and Hadassah Hospital. She made that trip three times!When another one of my college friends who made aliyah learned that I was in the hospital, he visited me almost every day bringing food for me and Judy. One of his last visits he came dressed as a clown and made me laugh for the first time since my bicycle accident. I was touched that one of my Talmud teachers came to visit me while I was in the hospital. One of my colleagues taught me through his example that the visit did not have to be long to be effective.  He concluded his visit with a prayer for healing.

Back in the states one of my study partners came a couple times and we sat down and studied some Torah. The food in the second rehab center was terrible. One of my friends brought me dinner. She purchased the most delicious kosher hamburger I have ever eaten. I was blessed with so many visitors that the guard remarked he should have already memorized my room number because so many people asked for it. Because of these visits, I knew it was truly blessed. All these visits aided my recovery and healing.

I would like to conclude by sharing with you something from the blog talmudolgy.com on the science behind visiting the sick. I recommend reading the entire blog.

"Writing in The Journal of the American Medical Association in 2004, Donald Berwick and Meeta Kotogal called for a change in the policy of restricted visiting hours in intensive care units.  They noted three areas which are often of concern to ICU staff when considering the question of visiting hours.  They also noted that although these concerns seem reasonable, the scientific literature tells "quite a different story."

Physiologic Stress for the Patient: "The concern that the patient should be left alone to rest incorrectly assumes that family presence at the bedside causes stress. The empirical literature suggests that the presence of family and friends tends to reassure and soothe the patient, providing sensory organization in an overstimulated environment and familiarity in unfamiliar surroundings. Visits of family and friends do not usually increase patients’ stress levels, as measured by blood pressure, heart rate, and intracranial pressure, but may in fact lower them. Nursing visits, on the other hand, often increase stress." 

Barriers to the Provision of Care: "The second concern is that the unrestricted presence of loved ones at the bedside will make it more difficult for nurses and physicians to do their jobs and may interfere with the delivery of care. The evidence suggests, however, that the family more often serves as a helpful support structure, increasing opportunities for patient and family education, and facilitating communication between the patient and clinicians." 

Exhaustion of Family and Friends: "The third concern is that constant visiting with the patient may prove exhausting for family and friends who fail to recognize the need to pace themselves. While that does sometimes happen, it is also true that open visiting hours help alleviate the anxiety of family and friends, allowing them to spend time with the patient when they want and to feel more secure and relaxed during the time they are not with the patient. One study found that open visitation had a beneficial effect on 88% of families and decreased anxiety in 65% of families."

A review of visitation policies in ICUs produced by the American College of Critical Care Medicine Task Force went one step further and found "no evidence that pets that are clean and properly immunized should be restricted from the ICU environment." So don't forget to bring the dog next time you visit a family member or friend in the ICU (or anywhere else for that matter). 

“...the preponderance of the literature supports greater flexibility in ICU visitation policies. Descriptive studies of the physiologic effects of visiting on mental status, intracranial pressure, heart rate, and ectopy demonstrated no physiologic rationale for restricting visiting. In fact, in seven of 24 patients with neurologic injuries, family visits produced a significant positive effect, measured by decrease in intracranial pressure.

— Davidson et al. Clinical practice guidelines for support of the family in the patient-centered intensive care unit: American College of Critical Care Medicine Task"